1. ‘Town Planning’: can it help? Sue Roberts For the Diabetes Team

2. ‘Then you should say what you mean’ the March Hare went on ‘I do’ Alice replied ‘at least – I mean what I say…’

3. What do these mean to you? Do they all mean the same?  Integrated care pathway.  Patient pathway  Patient journey  Care pathway  A ‘pathway approach’

4. Diabetes Do Once and Share

5. Planning Levels Level 1 Level 2 Level 3 Level 4 National & generic Locally defined

6. Level 1 : Like a map Diabetes NSF   

7. Level 1 : Like a map Diagnosis Continuing management specialist renal advice Pre RRT treatment and choices Dialysis and transplantation End of life care Renal NSF

8. Planning Levels Level 1 Level 2 Level 3 Level 4 National & generic Locally defined

9. Level 2: drilling down – the ‘town plan’ Quality criteria Workforce competencies NICE Guidance/ HTAs Do Once and Share Data items for EHR Continuing Care Care planning Structured education Psychological support

10. Planning Levels :National Level 1 Level 2 Level 3 Level 4 Locally defined NSFs, More definition, Quality criteria, NICE, HTAs competencies etc

11. Level 3: The local diabetes / renal community: Designing and building Your model of care Your workforce Designing your town 2 ry 3 ry 1 ry com ………and commissioning IC

12. Planning Levels Level 1 Level 2 Level 3 Level 4 NSFs, More definition, Quality criteria, NICE, HTAs competencies etc Local Model of care – matched to local need

13. Level 4: ‘Running the show’  How the model works in practice Who does what / when / In what order Referral pathways What the patient can expect to happen With knowledge support  Can be presented as algorithms  Should be audited The town council Care pathways!

14. Planning Levels Level 1 Level 2 Level 3 Level 4 NSFs, More definition, Quality criteria, NICE, HTAs competencies etc Local Model of care – matched to local need Care pathways

15. Responsibilities at each level LevelResponsibility 1 National responsibility, Diabetes / Renal NSF already published 2 National working groups 3 PCT Commissioning: Local diabetes networks need to develop models of care to inform this 4 Providing: Local diabetes networks should develop their local care pathways once model of care has been agreed

16. What local services like to do! Level 1 Level 2 Level 3 Level 4 NSFs, More definition, Quality criteria, NICE, HTAs competencies etc Local Model of care – matched to local need Care pathways

17. Roles for networks on behalf of Local Health Communities (LHCs) RoleActionLevel of activity CommissioningDesign, Advise (possibly commission) local models Level 3 Co-ordinationCo-ordinate (possibly manage) local services once model agreed Level 4 Audit and Monitoring Audit / monitor to feed into service improvement and future commissioning (and demonstrate contract compliance) Level 4

18. Conclusions  The NHS needs clinicians and patients to get involved  The language of levels Explains what needs to be done Clarifies national vs. local Helps people see their roles Enables discussion within /between disciplines and services  So that… Patients experience high quality services matched to their local need

19. Thank you!

21. Level 3: The local diabetes / renal community: Designing and commissioning Designing your town 2 ry 3 ry 1 ry com IC Your model of care Your skill mix

22. Diagnosis Continuing management specialist renal advice Pre RRT treatment and choices Dialysis and transplantation End of life care

23. Level 2: drilling down Quality criteria Workforce competencies Knowledge Support Do Once and Share The EHR Continuing Care Care planning Structured education Psychological support

24. Level 2: drilling down Quality criteria Workforce competencies Knowledge Support Do Once and Share The EHR Continuing Care Care planning Structured education Psychological support